1932250529 NPI number — DR. JAMES EDWARD BERWICK DDS

Table of content: DR. JAMES EDWARD BERWICK DDS (NPI 1932250529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932250529 NPI number — DR. JAMES EDWARD BERWICK DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERWICK
Provider First Name:
JAMES
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932250529
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 N ACADEMY BLVD
Provider Second Line Business Mailing Address:
STE 213
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80917-5321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-579-4060
Provider Business Mailing Address Fax Number:
719-574-2140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 N ACADEMY BLVD
Provider Second Line Business Practice Location Address:
STE 213
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80917-5321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-579-4060
Provider Business Practice Location Address Fax Number:
719-574-2140
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  7202 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02072023 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com